barbara versage
TRANSCRIPT
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Using Toyota Lean PrincipalstoImprove Inpatient Flow Process
May 18, 2009Improving Inpatient Flow
Barbara Versage RN, MSN, MBA
System for Partners in Performance Improvement
Lehigh Valley Health NetworkLean Consultant
Barbara Versage has no relevant financial relationships or affiliations to disclose in regard to the content of thispresentation.
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Presentation Objectives1) Application of Toyota Production System (TPS)
concepts to Improve Inpatient Flow
2) Using Value Stream Analysis to ensure cross-functional department performance
3) Identify a measurement matrix used to
determine the success of applying lean in
hospital flow.
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14 Toyota Way Principals
I. Long Term Philosophies1) Base decisions on long term philosophies
II. Right Process Produce Right Results
2) Create continuous flow
3) Use pull systems
4) Level out the workload
5) Build a culture of stopping to fix problems6) Standardize tasks
7) Use visual control
8) Use only reliable well tested technology
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14 Toyota Way Principals
III. Add Value to the Organization by DevelopingYour People and Partners9) Grow leaders who understand and use the concepts
10) Develop exceptional people and teams who follow yourphilosophies
11) Respect your extended network of supplies and partners
IV. Continuously Solving Root Problem DrivesOrganizational Learning
12) Go and see for yourself to thoroughly understand
13) Make decisions slowly by consensus; implement rapidly
14) Learn through continuous improvement & reflection
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14 Toyota Way Principals
I. Long Term Philosophies1) Base decisions on long term philosophies
II. Right Process Produce Right Results
2) Create continuous flow
3) Use pull systems
4) Level out the workload
5) Build a culture of stopping to fix problems6) Standardize tasks
7) Use visual control
8) Use only reliable well tested technology
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The Times They Are Changing
.Bob Dylan
Decreasing reimbursement Increasing uncompensated care
Increased cost of capital
Medical Tourism Consumer Expectation
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The patient
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14 Toyota Way Principals
I. Long Term Philosophies1) Base decisions on long term philosophies
II. Right Process Produce Right Results
2) Create continuous flow
3) Use pull systems
4) Level out the workload
5) Build a culture of stopping to fix problems6) Standardize tasks
7) Use visual control
8) Use only reliable well tested technology
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Department
ActivityUnit
Department
ActivityUnit
Value Stream
Department
ActivityUnit
VALUE STREAM
Department
ActivityUnit
Department
ActivityUnit
Department
ActivityUnit
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CONSULTS
PHYSIC
ALTHERAPYPH
YSICIAN
COLLOBORATIVERO
UNDS
Value Stream
ADMISSION
VALUE STREAM
LAB&HEARTSTATION
SUP
PLIES&EQUIPM
ENT
DISCHARGE
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Total Flow Time for Patient
90 % NVA 10%
Value
Adding
Arrive Leave
Value Adding Work
30%-40% of Health care costs are due to waste.
Education for Lean Healthcare Institute
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8 Wastes in Healthcare: U-WIT-D-MOP
Unused Human Potential: Untapped creativity/talent/injuries
Waiting: patients/providers/material
Inventory: stacks of work/piles of supplies
Transportation: transporting people, paperwork
Defects: wrong information/rework
Motion: finding information/double entry/searching
Overproduction: duplication/extra information
Processing: extra steps/checks/workarounds
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ProcessMap
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Communication Circle
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Spaghetti
Diagram
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Time Study
Prep
Wait
Test
Misc
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8 Wastes in Healthcare: U-WIT-D-MOP
Unused Human Potential: Untapped creativity/talent/injuries
Waiting: patients/providers/material
Inventory: stacks of work/piles of supplies
Transportation: transporting people, paperwork
Defects: wrong information/rework
Motion: finding information/double entry/searching
Overproduction: duplication/extra information
Processing: extra steps/checks/workarounds
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14 Toyota Way Principals
I. Long Term Philosophies1) Base decisions on long term philosophies
II. Right Process Produce Right Results
2) Create continuous flow
3) Use visual control
4) Level out the workload
5) Use pull system6) Standardize tasks
7) Build a culture of stopping to fix problems
8) Use only reliable well tested technology
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Where is your stuff?
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Sort
Remove items not needed daily (red-tag process)
Set in Order Label items and make it obvious where they belong
Shine/Sweep Clean and inspect everything, inside and out Visually sweep area to make sure everything is in its place
Safety Required safety information is posted
Exits and emergency equipment are clearly marked and functional
Standardize Establish policies and Standard Work to ensure 6S
Sustain Training, discipline, daily activities, self-audits
6S
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Total Calls from 5Kto SDS for Supplies
0
10
20
30
40
50
60
70
80
90
8/4 8/18 9/1 9/15 9/29 10/13
#ofCalls
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5KStaff Satisfaction with changes
4.8
Equipment Room 1 -------------------------------- 5
4.0
Supply Room 1 -------------------------------- 5
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14 Toyota Way Principals
I. Long Term Philosophies1) Base decisions on long term philosophies
II. Right Process Produce Right Results
2) Create continuous flow
3) Use visual control
4) Level out the workload
5) Use pull system6) Standardize tasks
7) Build a culture of stopping to fix problems
8) Use only reliable well tested technology
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Discharge Work Load
0
1
2
34
5
6
7
Day ShiftRN
EveningShift RN
Night ShiftRN
Provider CaseManager
#
ofTa
sks
BeforeAfter
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Order to Results Available - Echo
Random Weekday Sample
0
5
10
15
20
25
30
35
40
Patient#
14
Patient#
13
Patient
#1
Patient
#8
Patient
#2
Patient#
10
Patient
#9
Patient#
12
Patient
#6
Patient
#7
Patient#
15
Patient
#4
Patient#
11
Patient
#3
Patient
#5
Patient#
16
Hrs
Random Readingunsure of when tests available
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Heart Station Readings-
Load Level
0
2
4
6
8
10
12
14
#1 #4 #7 #10 #13 #16 #19 #22 #25
Patients
Hours
Complete to Results Available
05
10
15
20
25
30
35
40
#1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13 #14 #15 #16
Patient Number
Hours
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14 Toyota Way Principals
I. Long Term Philosophies1) Base decisions on long term philosophies
II. Right Process Produce Right Results
2) Create continuous flow
3) Use visual control
4) Level out the workload
5) Use pull system6) Standardize tasks
7) Build a culture of stopping to fix problems
8) Use only reliable well tested technology
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Standard Work
Defines the most efficient way to performthat task
Is known and followed by all who performthat task
Is the basis for all continuous improvement
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14 Toyota Way Principals
II. Right Process Produce Right Results7) Build a culture of stopping to fix problems
8) Use only reliable well tested technology
III. Add Value to the Organization by Developing Your Peopleand Partners9) Grow leaders who understand and use the concepts
10) Develop exceptional people and teams who follow your philosophies
11) Respect your extended network of supplies and partners
IV. Continuously Solving Root Problem Drives Organizational
Learning12) Go and see for yourself to thoroughly understand
13) Make decisions slowly by consensus; implement rapidly
14) Learn through continuous improvement & reflection
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Objectives Summary
1) Application of Toyota Production System (TPS)
concepts to Improve Inpatient Flow
2) Using Value Stream Analysis to ensure cross-functional department performance
3) Identify a measurement matrix used to
determine the success of applying lean in
hospital flow.
-
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References:
Liker, Jeffrey, The Toyota Way. McGraw-Hill Publishers,Madison, WI 2004.
Maskell, Brian and Baggaley, Bruce. Lean Accounting:Whats It All About? Association for Manufacturing
Excellence's, Target Magazine. September 2006.http://www.leanaccountingsummit.com/LeanAccountingDefined-Target.pdf
Johnson, H.Thomas, Lean Dilemma: Choose SystemProncipals or Management Accounting Controls, Not
Both, September 2006http://www.in2in.org/insights/TomJohnson-LeanDilemma.pdf